| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
20,658 |
20,562 |
$1.18M |
| D1120 |
Prophylaxis - child |
23,656 |
23,550 |
$917K |
| D0230 |
Intraoral - periapical each additional radiographic image |
151,240 |
25,772 |
$612K |
| D1351 |
Sealant - per tooth |
18,518 |
6,131 |
$526K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,546 |
6,526 |
$416K |
| D2140 |
|
6,937 |
3,775 |
$374K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
5,238 |
2,918 |
$349K |
| D1110 |
Prophylaxis - adult |
3,209 |
3,188 |
$281K |
| D1310 |
|
5,342 |
5,320 |
$243K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,588 |
5,399 |
$219K |
| D0274 |
Bitewings - four radiographic images |
10,294 |
10,233 |
$218K |
| D1208 |
Topical application of fluoride, excluding varnish |
18,981 |
18,896 |
$205K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,688 |
785 |
$195K |
| D9993 |
|
2,921 |
2,917 |
$188K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,197 |
1,812 |
$179K |
| D0350 |
|
15,856 |
7,932 |
$170K |
| D1206 |
Topical application of fluoride varnish |
8,083 |
8,047 |
$164K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,581 |
728 |
$153K |
| D0210 |
Intraoral - complete series of radiographic images |
3,076 |
3,075 |
$144K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
879 |
409 |
$103K |
| D7240 |
Removal of impacted tooth - completely bony |
433 |
179 |
$98K |
| D0330 |
Panoramic radiographic image |
2,189 |
2,185 |
$64K |
| D0220 |
Intraoral - periapical first radiographic image |
5,006 |
4,981 |
$57K |
| D0272 |
Bitewings - two radiographic images |
4,128 |
4,124 |
$47K |
| D0603 |
|
1,822 |
1,813 |
$27K |
| D9430 |
|
799 |
777 |
$25K |
| D0145 |
Oral evaluation for a patient under three years of age |
374 |
374 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
610 |
610 |
$21K |
| D4341 |
|
232 |
61 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
291 |
115 |
$16K |
| D4910 |
|
204 |
204 |
$16K |
| D2740 |
Crown - porcelain/ceramic |
32 |
25 |
$15K |
| D0602 |
|
952 |
946 |
$14K |
| D1320 |
|
902 |
902 |
$12K |
| D7230 |
|
45 |
25 |
$9K |
| D8670 |
Periodic orthodontic treatment visit |
26 |
26 |
$8K |
| D0340 |
|
149 |
149 |
$7K |
| D0601 |
|
443 |
443 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
48 |
31 |
$3K |
| D2330 |
|
40 |
18 |
$3K |
| D2160 |
|
38 |
29 |
$3K |